The need for wastewater surveillance of enteroviruses in the Philippines
Authors: John Paulo G Jose, Sheila DA Mantaring, John Paul Matthew D Guzman
Journal: The Lancet Microbe (2022)

Nguyen-Tran and colleagues,1Nguyen-Tran H Park SW Messacar K et al.Enterovirus D68: a test case for the use of immunological surveillance to develop tools to mitigate the pandemic potential of emerging pathogens.Lancet Microbe. 2022; 3: e83-e85Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar in a 2022 paper in The Lancet Microbe, emphasised that both pathogen surveillance and immunological surveillance are important in addressing emerging pathogens, such as enteroviruses, and preparing for future epidemics and pandemics. The ongoing COVID-19 pandemic showed the urgent need for a comprehensive surveillance system to rapidly address threats of pathogens which can potentially cause health crises.The environment plays an important role in disease transmission; bodies of water and sewage systems can harbour pathogens, including enteroviruses. Monitoring sewage systems provides an excellent early warning indicator for COVID-19 infection, as the presence of the virus in wastewater is strongly linked with incidence of active infection and reported hospitalisations.2Lastra A Botello J Pinilla A et al.SARS-CoV-2 detection in wastewater as an early warning indicator for COVID-19 pandemic. Madrid region case study.Environ Res. 2022; 203111852Crossref PubMed Scopus (14) Google Scholar Enteroviruses are responsible for various human infections, so early detection of these viruses would substantially contribute to the prevention of gastrointestinal diseases. In 2017, enteroviruses were reported to occur in high concentrations in both influents and treated effluents in Italy.3Pennino F Nardone A Montuori P et al.Large-scale survey of human enteroviruses in wastewater treatment plants of a metropolitan area of southern Italy.Food Environ Virol. 2017; 10: 187-192Crossref PubMed Scopus (9) Google Scholar Thus, detecting enteroviruses in wastewater could serve as an early warning indicator for viral infections caused by this group of viruses.In the Philippines, national health authorities conduct routine clinical and immunological surveillance of enteroviruses in patients with acute flaccid paralysis. A 2020 epidemiological survey reported the prevalence of non-polio enteroviruses (NPEVs) to be around 25% in healthy children younger than 6 years in the Philippines, caused by a total of 19 different serotypes of enteroviruses. This finding led to the conclusion that the occurrence of NPEVs in healthy children in the Philippines is indicative of faecal-oral transmission of enteroviruses.4Jiao MMA Apostol LN de Quiroz-Castro M et al.Non-polio enteroviruses among healthy children in the Philippines.BMC Public Health. 2020; 20: 1-7Crossref PubMed Scopus (6) Google Scholar However, current standards for wastewater in the country only require the detection of coliform bacteria for monitoring of water quality.5Department of Environment and Natural ResourcesDENR Administrative Order No. 2016–08: water quality guidelines and general effluent standards. 2016: 1–25.https://emb.gov.ph/wp-content/uploads/2019/04/DAO-2016-08_WATER-QUALITY-GUIDELINES-AND-GENERAL-EFFLUENT-STANDARDS.pdfDate accessed: May 31, 2022Google ScholarConsidering the route of transmission of enteroviruses, perhaps it is time that environmental surveillance of enteroviruses (eg, in wastewater) is reviewed to be included as part of the routine monitoring of quality of water and wastewater in the Philippines to provide our health authorities with additional information on early indications of enteroviral infections. Knowing which environments enteroviruses can be found in and spread from, and how they are transmitted early on, will enable us to combat these pathogens before they can cause diseases. Nguyen-Tran and colleagues,1Nguyen-Tran H Park SW Messacar K et al.Enterovirus D68: a test case for the use of immunological surveillance to develop tools to mitigate the pandemic potential of emerging pathogens.Lancet Microbe. 2022; 3: e83-e85Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar in a 2022 paper in The Lancet Microbe, emphasised that both pathogen surveillance and immunological surveillance are important in addressing emerging pathogens, such as enteroviruses, and preparing for future epidemics and pandemics. The ongoing COVID-19 pandemic showed the urgent need for a comprehensive surveillance system to rapidly address threats of pathogens which can potentially cause health crises. The environment plays an important role in disease transmission; bodies of water and sewage systems can harbour pathogens, including enteroviruses. Monitoring sewage systems provides an excellent early warning indicator for COVID-19 infection, as the presence of the virus in wastewater is strongly linked with incidence of active infection and reported hospitalisations.2Lastra A Botello J Pinilla A et al.SARS-CoV-2 detection in wastewater as an early warning indicator for COVID-19 pandemic. Madrid region case study.Environ Res. 2022; 203111852Crossref PubMed Scopus (14) Google Scholar Enteroviruses are responsible for various human infections, so early detection of these viruses would substantially contribute to the prevention of gastrointestinal diseases. In 2017, enteroviruses were reported to occur in high concentrations in both influents and treated effluents in Italy.3Pennino F Nardone A Montuori P et al.Large-scale survey of human enteroviruses in wastewater treatment plants of a metropolitan area of southern Italy.Food Environ Virol. 2017; 10: 187-192Crossref PubMed Scopus (9) Google Scholar Thus, detecting enteroviruses in wastewater could serve as an early warning indicator for viral infections caused by this group of viruses. In the Philippines, national health authorities conduct routine clinical and immunological surveillance of enteroviruses in patients with acute flaccid paralysis. A 2020 epidemiological survey reported the prevalence of non-polio enteroviruses (NPEVs) to be around 25% in healthy children younger than 6 years in the Philippines, caused by a total of 19 different serotypes of enteroviruses. This finding led to the conclusion that the occurrence of NPEVs in healthy children in the Philippines is indicative of faecal-oral transmission of enteroviruses.4Jiao MMA Apostol LN de Quiroz-Castro M et al.Non-polio enteroviruses among healthy children in the Philippines.BMC Public Health. 2020; 20: 1-7Crossref PubMed Scopus (6) Google Scholar However, current standards for wastewater in the country only require the detection of coliform bacteria for monitoring of water quality.5Department of Environment and Natural ResourcesDENR Administrative Order No. 2016–08: water quality guidelines and general effluent standards. 2016: 1–25.https://emb.gov.ph/wp-content/uploads/2019/04/DAO-2016-08_WATER-QUALITY-GUIDELINES-AND-GENERAL-EFFLUENT-STANDARDS.pdfDate accessed: May 31, 2022Google Scholar Considering the route of transmission of enteroviruses, perhaps it is time that environmental surveillance of enteroviruses (eg, in wastewater) is reviewed to be included as part of the routine monitoring of quality of water and wastewater in the Philippines to provide our health authorities with additional information on early indications of enteroviral infections. Knowing which environments enteroviruses can be found in and spread from, and how they are transmitted early on, will enable us to combat these pathogens before they can cause diseases. We declare no competing interests.